June 25, 2023 • 25 mins
06/25/23
The Healthy Matters Podcast
S02_E14 - Autism 101
Did you know that Albert Einstein didn't speak until around the age of 3? That being the case, it's quite possible that if he had been screened he might well have been diagnosed with Autism. But what is Autism exactly? How is it actually screened and diagnosed? And what is life like for those living with it?
Join us for Episode 14 of the Healthy Matters Podcast, where we'll go over what we know and what we don't know about Autism. We'll be joined by Dr. Krishnan Subrahmanian (MD, MPhil, DTM), a Pediatrician at Hennepin Healthcare to cover the basics of the condition, define what "the spectrum" actually means, its prevalence around the globe, and much more. There's so much to be discussed when it comes to Autism, but this is certainly a great place to start. Join us!
To learn more about Autism, or to find resources in Minnesota, visit:
Fraser
Autism Society of Minnesota
Autism Speaks
Got a question for the doc? Or an idea for a show? Contact us!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Twitter - @drdavidhilden
Find out more at www.healthymatters.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden .
Speaker 2 (00:20):
Hey everybody. Dr.
David Hilden here. And this isepisode 14 of the Healthy
Matters podcast. Thanks forjoining us today. We are gonna
talk about autism. To help meout, I've asked Dr. Christian
on Subramanian. You mightremember him from episode one
of season two. He is apediatrician here with me at
Hennepin Healthcare in downtownMinneapolis. We're gonna talk
(00:42):
about all things autism, about,what is it, how common is it?
And what is life like forpeople living with autism? Dr.
Kris , thanks for being back onthe show.
Speaker 3 (00:52):
Uh , thank you so much Dr. Hilton , for having
me. Um, and, and thanks forhighlighting some wonderful
neighbors of ours, neighborswho have autism and, and the
community of incredible peoplewho are doing amazing things.
I'm
Speaker 2 (01:03):
Really excited to talk about this very topic, and
I love the way you just framedthat. Start us off, what is
autism? Yeah.
Speaker 3 (01:11):
So autism is a neurodevelopmental disorder or
difference that changes andaffects the way people
communicate and behave. Sodigging down on that a little
bit, there's a communicationpiece and a behavior piece.
When we think aboutcommunication, we think about
language. You know, one of thejobs of pediatricians is to
(01:32):
monitor development. We'reasking, checking in with
families about how is your babycommunicating? And at the
earliest stages, that's abouthow are they making sounds or
looking at you. And then asthey get older, it becomes how
are they communicating withwords or language , uh, or in
other ways. Uh, one of thethings when it comes to autism
(01:54):
is that there are differencesin the way that children
communicate. They do a littlebit different back and forth
communication. Right now, youand I are having a
conversation, and we're goingback and forth. Some kids with
autism don't do that quite asmuch. They don't go back and
forth with communication. Theyhave differences in the way
they communicate withnon-verbal communication. Um,
(02:17):
we oftentimes use our eyes andour smiles and to, to convey
emotions in autism. Childrenand , and adults frequently
won't do that. Also, we notethat , uh, there's a difference
in understanding ofrelationships. So kids with
autism or, or adults withautism may do a little bit less
imaginative play. They may havesome differences in the way
(02:39):
they make friends and , and theway they communicate with those
friends. So that , those areall sorts of , sort of the
communication pieces we thinkof. And that's
Speaker 2 (02:47):
Only half of it.
That's
Speaker 3 (02:49):
Half of it. So you, you know, when we talk about
diagnosing autism, we, we tendto see those symptoms. And then
there's another few behavioralsymptoms that we'll see in
young people who have autism.
So there may be some repetitivebehaviors. Kids and adults may
focus on certain behaviors thatthey wanna repeat over and over
again. It may be certainmotions, certain objects and
(03:12):
things that they like to playwith and do. Additionally,
there may be a , a highlyregimented behavior. So some
kids or adults may really wantthings in a certain way. They
want things lined up in acertain way. They want their
room to look a certain way. Andthat is one symptom we think of
when it comes to the behaviors.
Also, some kids and adults whohave autism may have very
(03:34):
specific interests. So acertain type of animal or a
certain type of object orvehicle, cars, trains that they
really like. And that is a typeof repetitive behavior that we
see , uh, in folks with autism.
And then , and then finally,very importantly is people with
autism may have differences inthe way they have sensation.
They may be very sensitive ordifferently sensitive to touch
(03:59):
to certain tastes, to certaintextures. And so when you put
this together, autismrepresents a difference in the
way people communicate andbehave . That can sometimes get
in the way of the way they'reable to communicate with
others.
Speaker 2 (04:14):
So you used a couple of words, I'm gonna go back to
you used it might be a disorderor might maybe more accurately
be reflected as a difference.
Yes . Is it a disorder at all?
Speaker 3 (04:26):
So right now we diagnose autism with something
called the D S M five. It's adiagnostic and statistical
manual. And it asks, do you seethese criteria in a young
person? And in particular, acouple caveats , uh, on that
diagnosis. Uh, we should seesome of those symptoms at an
early age. We should also seesome , uh, effect on their
(04:49):
daily life to call it autismspectral disorder. Mm-hmm.
Speaker 2 (04:54):
. So
Speaker 3 (04:54):
That , that may be the key difference, is that
does it have some effect ontheir daily, daily life and the
way that people engage in thatdaily life. I think a lot of
the things we just talkedabout, Dr. Hedon , whether it's
differences in the way wecommunicate, liking things a
certain way, having differentsensations are things that you
might see in a lot of people.
Mm-hmm., I thinkit's when you collect them, and
(05:15):
then when it begins to havesome effect on folks daily
lives, that's when you can callit a , a disorder. But , uh,
there is a , there's a largespectrum. There's a large
spectrum. And , uh, it is , uh,encompassing of a lot of people
in a lot of , uh, differentways that autism may manifest.
Speaker 2 (05:32):
So you used the word, the spectrum, and many of
us have heard this term before.
Um, in fact, maybe some of useven use it in our daily lives
. Oh, he or she's , uh, on thespectrum maybe without really
knowing what we're talkingabout, first of all, is that an
accepted term? And second ofall, what do we mean by that?
Yeah,
Speaker 3 (05:49):
I , I , I hope that the term autism spectrum is
seen as an encompassing term torepresent really the beautiful
diversity of people who haveautism and frankly, the
beautiful diversity of peoplewho, who live in our community.
Because we just talked about ,uh, a variety of symptoms. We
talked about some communicationsymptoms. We talked about some
behavioral symptoms. And thetruth is, every single person
(06:12):
with autism, the millions ofpeople in our country who have
autism, have a slightlydifferent version of that. Um,
some may have differences inthe way they communicate with
language. Some may have , uh,certain strong preferences
around sensation. Some may havestrong , uh, preferences in the
way things are laid out. So
Speaker 2 (06:28):
You can't just say, here's what it always looks
like in every person. And
Speaker 3 (06:31):
Every single one of our neighbors with autism has a
slightly different variation ofthat. And that is
representative, I think, of thespectrum. But then I also think
there's a , an element of thespectrum that, that represents.
Some people with autism havevery little effect on their
daily lives. It affects theirdaily lives, but, but not in a
way where they need significantlevels of services from other
(06:52):
people to get through dailylife. Whereas there are other
neighbors who have autism whoreally need a lot of support to
do their daily functioning anddaily life activities. And so I
think that is another level ofthe spectrum, is that there are
various levels of, of intensityof services. And so I hope the
term , uh, spectrum allows usto see that every individual
(07:12):
with autism is different, hasdifferent needs. And, and
really one of ourresponsibilities as providers,
as community members and asneighbors, is to get to know
every individual and find outwhat are the ways that we can
support that individual.
Speaker 2 (07:25):
Yeah. That is so powerful. What the way you
frame that, I really, reallylike that. But do we know
what's happening in the brainfor people with autism? And ,
and , and I guess that'sanother way of saying, do we
know what causes this?
Speaker 3 (07:38):
Yeah. So let , let's start with the brain and then
I'll, I'll turn into like, yeah. What , what co what causes ,
um, you know, there's some verylarge scale evidence from, from
brain imaging to suggest thatthere might be some, some
consistent patterns. Uh, somaybe people with, with autism
have slightly smallerhippocampus, slightly enlarged
amygdalas, different parts ofthe neuroanatomy that are, are
(08:00):
slightly different over, overthe large scale. One thing
that's really interesting isseeing, they , they're using
MRI now to map connectivity ofpathways, which is just
beautiful science and beautifulimaging. And you can see the
way that different parts of thebrain connect with each other.
One of the things , uh, that isseen is people with autism
(08:23):
actually have veryindividualized idiosyncratic
patterns. So they have maybevery strong visual pathways or
very , maybe very strongconnections between visual
pathways a and language. Sothey may have very unique
strengths within their brainpathways that are really re uh
(08:44):
, really strong. And that's,it's , that's a cool thing to
see that our , our neighborswith autism have, have some
incredible unique strengthsthat are visualized in the
brain.
Speaker 2 (08:54):
You can actually see them on advanced imaging like
an mri . Yeah.
Speaker 3 (08:57):
Yeah. There's, there's a , there's a professor
out of Colorado State namedTemple Grandon . She has autism
and , uh, speaks, she , shestudies animal sciences, but
she speaks a lot about livingwith autism and, and what ,
what we can do to help ourneighbors with autism. And she
talks about how her, she , hervisual cortex has been , uh,
mapped out. And you can see inthe imaging, it's just so much
(09:20):
bigger than, wow , frankly,yours are my , you know, yours
are mine, David. Um, but it's,it's a remarkable thing. But,
you know, Dr. Granton alsotalks about how that these
strengthened pathways inwhatever way they are, are ,
are the seeds of someincredible things in our
community. You know, we, shetalks about , uh, a , a young
Albert Einstein, you know, anda young Albert Einstein didn't
(09:40):
talk till he was the age ofthree. Mm-hmm . ,
he liked his blocks in acertain way and lined them up
in a very certain way. Would hehave been diagnosed with
autism? Very likely. You know,very, very likely. And,
Speaker 2 (09:51):
And is not what people call the genius. If you
think of a genius, you think ofEinstein a
Speaker 3 (09:55):
Absolutely. The , the prototype of a genius that
Speaker 2 (09:57):
Prototype. And
Speaker 3 (09:58):
What does that mean?
It means that sometimes thesesymptoms that we just talked
about, this, this, this focuson certain things, this
interest in certain things ,uh, it can sometimes be the
seeds of the things that changethe world.
Speaker 2 (10:09):
Absolutely. So what causes
Speaker 3 (10:11):
It? So maybe it's easier to tackle Dr. Hilden .
What does not cause , what doesnot cause, what does not cause
autism? Um, I think there'sbeen a lot of talk about autism
over the last 30 years. And ,and one of those talks has
been, oh, is it vaccine related? I think one thing we can say
with as much proof as there isunder the sun,
Speaker 2 (10:30):
As certain as we can possibly be
Speaker 3 (10:32):
A , about anything that , uh, vaccines don't cause
autism. And , and I, and Iwanna make that a as
straightforward as
Speaker 2 (10:38):
Possible. I appreciate you laying that out
there ,
Speaker 3 (10:41):
. So, so
vaccines don't cause autism.
And, and I , I also think weoftentimes run, and I know
parents often think about whatdid , what , what am I doing?
What did I do? Yeah . Is it ,uh, no , we , we know. It's not
something that parents are, areconsuming or doing. You know,
this is not about, it's notabout parents. We think, and we
know that there are , uh,there's a genetic component to
(11:02):
autism. The challenge withthat, Dr. Hilton, is that
there's over a hundreddifferent genes that have some
connection peripherally or morestrongly to autism. And so to
try to synthesize that, it's,it's a difficult thing because
there's, it is somultifactorial.
Speaker 2 (11:18):
I love your message though. It's not what you did,
folks, you know , parents, youdidn't do this. Know your
vaccine, do and do it, andnothing you did. You don't,
this isn't your , somethingyou're responsible for. It's
nothing you personally did.
Speaker 3 (11:30):
Uh , no. And , and you know, we , we also know
that there's a, there is agenetic component because we
see that in, we do see it infamilies . So we will see, for
example, in in siblings,there's a higher preponderance
or concordance in , in twins ofa sibling having autism, and
then , uh, you know , theirsibling having autism. Right ?
Um, so, so we know that thereis a genetic component. We know
(11:51):
that there's some , um, somecorrelation, though the science
isn't great about paternal andmaternal age. The older we get
as we have children can havesome correlation. But the truth
is, Dr. Hilden , I, I thinkhere, here we see a hundred
genes. We see , uh, brainconnectivity in certain spots.
I , I think if we have youngscientists and researchers out
(12:12):
there who really wanna push theboundaries of knowledge, I , I
think one, learning the braingenerally is, is the new
frontier. And is the frontierof where, where science is
going. But I think autism inparticular is another space
that we have a lot to learn andhow you uncouple these hundred
genes.
Speaker 2 (12:28):
When we come back, we're gonna talk about
diagnosis and then we're gonnatalk about living with autism.
Stay with us. We'll be rightback after a short break.
Speaker 1 (12:37):
You are listening to the Healthy Matters podcast
with Dr. David Hilden . Got aquestion or comment for the
doc, email us at HealthyMatters hc m e d.org , or give
us a call at six one two eightseven three talk. That's
[inaudible] 8 7 3 8 2 5 5. Andnow let's get back to more
healthy conversation.
Speaker 2 (13:01):
You , you used the word earlier that millions of
Americans have this, so howcommon is it? Yeah,
Speaker 3 (13:07):
Right now they're saying , uh, as of this year,
one in 34 children are, arediagnosed. So we're talking
countrywide. About 2% ofAmericans have autism or on the
autism spectrum.
Speaker 2 (13:18):
Is that on the rise on the fall? Is it the same?
Speaker 3 (13:21):
If you had asked me this question in 2000, Dr .
Hedon , we would say one in 150Americans. So I would,
Speaker 2 (13:28):
That would conclude It's on the rise. Is that
wrong? You
Speaker 3 (13:31):
Would, you would be accurate that the number of
diagnosed people on the autismspectrum is on the rise now?
Was it that we wereunderdiagnosing, did we not
recognize? Uh , I , I thinkthat's a huge piece of it that
Speaker 2 (13:44):
Seems like it's enormous, that we simply
weren't identifying it as much.
And this
Speaker 3 (13:48):
Is a relatively young field, Dr. Hilden . Yeah
. You know, it , it wasn'tuntil 1940 that the first sort
of description of 11 kids withsome varia variation in
communication , uh, wasdescribed. And then, you know,
it wasn't until the , you know, 1970s, eighties till you got
a little bit more discussion onthat started to, to recognize.
(14:08):
And the amount of educationwe've done to providers, the
community ha , has beenenormous. And I think that's a
huge reason we're starting toidentify , uh, more folks with
some of these symptoms, youknow, landing on the autism
spectrum. I think it's alsopart and parcel, and I know
we're gonna talk about this, ofwe're recognizing more and
more, and , and this is part ofthe research advent, it's part
(14:29):
of the clinical advent , isthat we need to make early
diagnosis to help folks alongtheir path, right? We need to
make the diagnosis in order toget them services and the kinds
of therapies that, that willbenefit them for the rest of
their lives. And so, I , Ithink we as providers are
learning a lot. Our diagnosisis getting better. The
community knows a lot more. And, and so I think all those
(14:52):
things have, have seen a shiftfrom one in 150 to one in 34.
Is
Speaker 2 (14:55):
It more common in certain people are at some
groups more at risk, are boysor girls more at risk? Mm-hmm.
, talk about thatif you could please.
Speaker 3 (15:03):
Yeah. So, so you know, we talked a little bit
about how families, if you havea , a member of your family ,
uh, and a sibling , uh, aparent with, with autism, then
that is, is a risk. Uh, we knowthat it is more commonly
diagnosed in boys four times asmuch diagnosed in boys . So
it's, it's a pretty big disdisparity in our diagnosis. We
don't have a great reason forthat Exactly. But I think it
(15:24):
does beg the question of are wediagnosing it well and
consistently, and it'ssomething we need to be
thinking about a lot. Thepopulation rates are very
comparable across the world.
That's just looked at a mapthat mapped out by color on ,
you know , shading color on themap, the rates of autism. It
was a uniform map for the mostpart because it was a , just
(15:45):
about the same when no matterwhere you went, there's some
slight variation. France hasthe lowest diagnostic rate and
Qatar has the highest in the ,in the world. However, it is
not a huge disparity when youcompare it to, to other types
of illnesses in thedisparities. And if you look
at, in the United States, ifyou look at , uh, autism rates
by race and ethnicity,remarkable. And I have it here
(16:06):
with me, David, I want to hear2.1%, 2.2%, 2.2%, 2.3%. And
that's across different
Speaker 2 (16:14):
Racial groups.
Across racial groups. So it isthe same remarkably, almost
identically the same acrossracial groups. It ,
Speaker 3 (16:21):
It , it's remarkably similar. And, and
Speaker 2 (16:23):
That's shocking to me. It it
Speaker 3 (16:24):
Is, it's, it's, it's a surprise. Now, I will say, I
, I think if we we're lookingat diagnoses , um, yeah , we
know that our data suggeststhat we are slower to make the
diagnosis in African Americanand people of color. So it's,
it's a disparity that we needto address and we need to get
better at. And that, that'spartly outreach. It's partly
our conversations and, andmaking sure we're doing a good
(16:47):
job of, of screening anddiagnosing.
Speaker 2 (16:49):
How is it diagnosed?
Speaker 3 (16:50):
There's a few ways that we approach this
conversation. One, and , andit's always so welcome . And
one of the things I wannaencourage every family out
there is, one, talk to yourkid. Play with your kid , sing
to your kid. Uh, have have alot of conversations with them
and then check in with the c dt. Check in with your
pediatrician about what are thekinds of things that we would
expect a child at any given ageto do. And this starts from
(17:11):
birth two months, four months,nine months, all the way
through and just is my childdoing the things that I would
kind of expect? And
Speaker 2 (17:18):
Parents don't always know that
Speaker 3 (17:19):
A absolutely not.
And , and there's some reallygreat apps, there's some really
great websites. And then pleaseuse your providers as a, as a
resource to find out, oh , whatshould my kid be doing
approximately at this age? Andthere's always variation. I
wanna make that very clear. Buta at any point if you have
concerns that your child ismaybe not doing what you would
think, bring that up. Cuz thatis always a very welcome way to
(17:41):
begin a conversation. Well ,how do we make this, this
diagnosis? First, I wanna makeit clear that pediatricians
and, and family docs, at 18months and two years, we'll
always do a screening. We'llask a bunch of questions about
development and it'll give us asense of are there some
symptoms that might fall alongthe autism spectrum? And
Speaker 2 (17:59):
You do that with all kids.
Speaker 3 (18:00):
We do that with every kid. And , and so one of
the great things aboutscreening tools is that we use
it with every child. And , uh,we, we get a sense of if
there's any clues there. And ifthere are clues, we'll do some
further testing, furtherquestions, and we'll make
referrals to some of ourcolleagues who do deeper
testing and deeper analysis todetermine whether these
communication and behavioralsymptoms really are existing.
(18:23):
Now
Speaker 2 (18:23):
Is that a neurologist or are there people
who specialize specifically inautism spectrum?
Speaker 3 (18:29):
We , we are blessed with some incredible colleagues
and they fall along a coupledifferent avenues and
professional venues. So we dohave some pediatric
neurologists who, who , whowill do this. But , uh, more
commonly we have incrediblepsychologists in our, in our
community , uh, clinicalpsychologists, pediatric
psychologists who will sit downand do incredible conversations
and evaluations with, withyoung people determining
(18:49):
whether they have some of thesesymptoms. There are , there are
standardized scales thatthey'll use , uh, standardized
conversations and tests thatthey'll do with kids and, and
determine whether they fit thiscriteria for, for autism. But
one thing too, David, you don'tneed to wait for a screen,
right? Like we as pediatricianswill do the screen and we'll do
it at 18 and 24 months. But atany point, if a parent feels a
(19:14):
question or a concern, we canalways get that referral made
to our psychology colleagues,to our neurology colleagues.
Uh, we have developmentalpediatricians who, who
specialize in this space. Andthey are awesome. They're
wonderful. It's a funappointment in many ways cuz
it's , uh, it's a really niceplay event and we can get you
to those folks , uh, if youhave any concerns. So
Speaker 2 (19:35):
That , that's the message to parents. If you, if
you have questions about yourchild, ask your pediatrician.
Speaker 3 (19:40):
Yeah. And it doesn't matter whether we call it
autism spectral disorder, aspeech delay, a difference in
behavior. If we can get kidsmore therapy, more practice
with conversations andsocializations and ,
Speaker 2 (19:52):
And the sooner the better
Speaker 3 (19:52):
And the sooner the better. Frankly, the label
doesn't matter. And it , itmatters that we are helping the
young people do more andpractice more and, and helping
parents to help their kid. I'dlike
Speaker 2 (20:03):
To shift the r the rest of our conversation about
living with autism.
Speaker 3 (20:08):
So first thing I wanna acknowledge is that I
think anytime you give a kid adiagnosis of anything, it it ,
it's a , it's a shock and it'sa , it's a whoa, it's a whoa
moment for any, any parent. Weas pediatricians, we as a
community are there to walk,walk beside families. Um, so
there are some incredibleresources out there. There's
organizations that aresupporting families with
(20:29):
autism. So there , there'sFrazier, there's St . David,
there's a number of , uh,Minnesota Autism Center.
There's a lot of greatorganizations right here in our
community that are supportingwhat I, what I think it
represents. What does it meanwhen you , uh, you know, what
does life look like? So firstand foremost, I think at an
early age, it means we're gonnaget you the extra support.
We're gonna get you the extratherapy, we're gonna do the
extra practice. Minnesota and ,and frankly, our early child
(20:53):
infrastructure is, is reallyexceptional. Right away we make
a , we make a referral tospeech therapy, the kinds of
therapies that will support ,uh, a child with autism,
various modalities of therapythat, that help kids learn a
lot of the skills we're talkingabout. Uh , but we also have
the school districts, you know,we will refer to the school
district who will provide extratherapies and extra support for
(21:15):
kids in that first three yearsand beyond, all the way through
their educational career. So Ithink one of the key elements ,
uh, for I would encourage allparents to think about is if
you get that diagnosis, livingwith autism means finding the
resources that are gonna besupportive and relying on the
professionals around you tohelp you get to those
resources. So that's the ,that's the first thing. Uh ,
the second thing I'll say,David, is the spectrum is huge.
(21:37):
And for each individualthereafter, it's gonna be, it's
gonna be variable. Some kidswill need some minor supports
in their classroom setting.
Some kids will need the, thesocialization and friend groups
that come from a community andother kids may need significant
support. And , and thatspectrum can be so broad as we,
as we talked about earlier. Andso that will look very
(21:59):
different for each family. ButI think having a navigator,
having a someone who will walkalongside you becomes crucial.
What about
Speaker 2 (22:05):
Things like , uh, social relationships mm-hmm.
as children andthen into teenage years,
they're , you know, whererelationships are difficult for
all teenagers. Yeah. How do,how do young adults, teenagers
manage that? Yep .
Speaker 3 (22:19):
So it , it is through various modalities of
therapy. It's a lot of what ,um, our, our pediatric
therapist will work on withkids. Mm-hmm . is
how do we make friends? How dowe take turns? How do we do the
elements that are gonna make ussuccessful in a classroom
setting? Uh , I think one ofthe things I think about , um,
our , our pediatric therapistsdo an incredible job of helping
(22:39):
our kids with makingadaptations to be successful in
their world, right? I thinkthey do an incredible job long
Speaker 2 (22:44):
Into adulthood
Speaker 3 (22:45):
Then long into adulthood. But one of the
things that I think we asproviders, one of the things
that I think we as a communityand, and as organizations can
do is help the communityunderstand and adapt and make
places more welcoming, more ,um,
Speaker 2 (22:59):
Absolutely
Speaker 3 (23:00):
Amenable, more, more friendly and, and more honoring
of our neighbors with autism. Aand so I think it's a, it's a
simultaneous process of, ofsupporting our kids, but also
supporting our communities to,to learn to
Speaker 2 (23:11):
Be a little bit more welcoming. Not all spaces were
designed intentionally orotherwise for people living
with autism perhaps. So to wrapit up, it sounds to me, Kris ,
that , um, the world ischanging with regard to autism,
that there are more resources,there are, there's more
awareness at least of autism atleast, I hope so. What thoughts
would you leave us both forpeople living with autism and
(23:34):
for the communities about whatthe future should look like
with regard to people livingwith autism? Yeah, I,
Speaker 3 (23:41):
I I think we , we don't know , uh, what what will
happen next with our kids,right? None of us do. But from
an early age, talk to them,sing to them, play with them,
love them, love them, lovethem. And then use the
resources around you to help ,uh, guide next steps. Yeah. I'm
so excited that the communityis beginning to realize that,
(24:02):
that the autism spectrum is, iswide. It , it's broad and it
represents so many of ourneighbors with so many
different talents. And, and Ithink what I would hope is that
we begin to recognize thateveryone , uh, with autism,
everyone on the spectrum hasincredible talents, incredible
gifts, and that while they'reworking hard , uh, all of our
neighbors with autism areworking hard to learn skills.
(24:24):
Uh, we as a community should beworking equally as hard to
appreciate the incredible folksthat , that surround us.
Speaker 2 (24:29):
I will take that to heart. I think that's probably
my number one take home messagefrom this conversation with you
, Kris , is that the community, um, needs to do its part and
it's a privilege to, to do so.
What a great conversation todaywith Dr. Christian Subramanian
here from the Department ofPediatrics at Hennepin
Healthcare . I have learned awhole bunch. I hope you have as
well. If you like what youheard, please share the podcast
(24:51):
with your friends, leave us areview, and I certainly hope
you'll join us for the nextepisode. It's going to be a
great one. And in the meantime,be healthy, be well, and don't
forget to wear your sunscreen.
Speaker 1 (25:03):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy Matters hc m ed.org or call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. And finally, if you
(25:26):
enjoy the show, please leave usa review and share the show
with others. The HealthyMatters Podcast is made
possible by Hennepin Healthcarein Minneapolis, Minnesota, an
engineered and produced by JohnLucas At Highball Executive
producers are Jonathan Comitoand Christine Hill. Please
remember, we can only givegeneral medical advice during
this program, and every case isunique. We urge you to consult
(25:47):
with your physician if you havea more serious or pressing
health concern. Until nexttime, be healthy and be well .
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden .
Speaker 2 (00:20):
Hey everybody. Dr.
David Hilden here. And this isepisode 14 of the Healthy
Matters podcast. Thanks forjoining us today. We are gonna
talk about autism. To help meout, I've asked Dr. Christian
on Subramanian. You mightremember him from episode one
of season two. He is apediatrician here with me at
Hennepin Healthcare in downtownMinneapolis. We're gonna talk
(00:42):
about all things autism, about,what is it, how common is it?
And what is life like forpeople living with autism? Dr.
Kris , thanks for being back onthe show.
Speaker 3 (00:52):
Uh , thank you so much Dr. Hilton , for having
me. Um, and, and thanks forhighlighting some wonderful
neighbors of ours, neighborswho have autism and, and the
community of incredible peoplewho are doing amazing things.
I'm
Speaker 2 (01:03):
Really excited to talk about this very topic, and
I love the way you just framedthat. Start us off, what is
autism? Yeah.
Speaker 3 (01:11):
So autism is a neurodevelopmental disorder or
difference that changes andaffects the way people
communicate and behave. Sodigging down on that a little
bit, there's a communicationpiece and a behavior piece.
When we think aboutcommunication, we think about
language. You know, one of thejobs of pediatricians is to
(01:32):
monitor development. We'reasking, checking in with
families about how is your babycommunicating? And at the
earliest stages, that's abouthow are they making sounds or
looking at you. And then asthey get older, it becomes how
are they communicating withwords or language , uh, or in
other ways. Uh, one of thethings when it comes to autism
(01:54):
is that there are differencesin the way that children
communicate. They do a littlebit different back and forth
communication. Right now, youand I are having a
conversation, and we're goingback and forth. Some kids with
autism don't do that quite asmuch. They don't go back and
forth with communication. Theyhave differences in the way
they communicate withnon-verbal communication. Um,
(02:17):
we oftentimes use our eyes andour smiles and to, to convey
emotions in autism. Childrenand , and adults frequently
won't do that. Also, we notethat , uh, there's a difference
in understanding ofrelationships. So kids with
autism or, or adults withautism may do a little bit less
imaginative play. They may havesome differences in the way
(02:39):
they make friends and , and theway they communicate with those
friends. So that , those areall sorts of , sort of the
communication pieces we thinkof. And that's
Speaker 2 (02:47):
Only half of it.
That's
Speaker 3 (02:49):
Half of it. So you, you know, when we talk about
diagnosing autism, we, we tendto see those symptoms. And then
there's another few behavioralsymptoms that we'll see in
young people who have autism.
So there may be some repetitivebehaviors. Kids and adults may
focus on certain behaviors thatthey wanna repeat over and over
again. It may be certainmotions, certain objects and
(03:12):
things that they like to playwith and do. Additionally,
there may be a , a highlyregimented behavior. So some
kids or adults may really wantthings in a certain way. They
want things lined up in acertain way. They want their
room to look a certain way. Andthat is one symptom we think of
when it comes to the behaviors.
Also, some kids and adults whohave autism may have very
(03:34):
specific interests. So acertain type of animal or a
certain type of object orvehicle, cars, trains that they
really like. And that is a typeof repetitive behavior that we
see , uh, in folks with autism.
And then , and then finally,very importantly is people with
autism may have differences inthe way they have sensation.
They may be very sensitive ordifferently sensitive to touch
(03:59):
to certain tastes, to certaintextures. And so when you put
this together, autismrepresents a difference in the
way people communicate andbehave . That can sometimes get
in the way of the way they'reable to communicate with
others.
Speaker 2 (04:14):
So you used a couple of words, I'm gonna go back to
you used it might be a disorderor might maybe more accurately
be reflected as a difference.
Yes . Is it a disorder at all?
Speaker 3 (04:26):
So right now we diagnose autism with something
called the D S M five. It's adiagnostic and statistical
manual. And it asks, do you seethese criteria in a young
person? And in particular, acouple caveats , uh, on that
diagnosis. Uh, we should seesome of those symptoms at an
early age. We should also seesome , uh, effect on their
(04:49):
daily life to call it autismspectral disorder. Mm-hmm.
Speaker 2 (04:54):
Speaker 3 (04:54):
That , that may be the key difference, is that
does it have some effect ontheir daily, daily life and the
way that people engage in thatdaily life. I think a lot of
the things we just talkedabout, Dr. Hedon , whether it's
differences in the way wecommunicate, liking things a
certain way, having differentsensations are things that you
might see in a lot of people.
Mm-hmm.
(05:15):
then when it begins to havesome effect on folks daily
lives, that's when you can callit a , a disorder. But , uh,
there is a , there's a largespectrum. There's a large
spectrum. And , uh, it is , uh,encompassing of a lot of people
in a lot of , uh, differentways that autism may manifest.
Speaker 2 (05:32):
So you used the word, the spectrum, and many of
us have heard this term before.
Um, in fact, maybe some of useven use it in our daily lives
. Oh, he or she's , uh, on thespectrum maybe without really
knowing what we're talkingabout, first of all, is that an
accepted term? And second ofall, what do we mean by that?
Yeah,
Speaker 3 (05:49):
I , I , I hope that the term autism spectrum is
seen as an encompassing term torepresent really the beautiful
diversity of people who haveautism and frankly, the
beautiful diversity of peoplewho, who live in our community.
Because we just talked about ,uh, a variety of symptoms. We
talked about some communicationsymptoms. We talked about some
behavioral symptoms. And thetruth is, every single person
(06:12):
with autism, the millions ofpeople in our country who have
autism, have a slightlydifferent version of that. Um,
some may have differences inthe way they communicate with
language. Some may have , uh,certain strong preferences
around sensation. Some may havestrong , uh, preferences in the
way things are laid out. So
Speaker 2 (06:28):
You can't just say, here's what it always looks
like in every person. And
Speaker 3 (06:31):
Every single one of our neighbors with autism has a
slightly different variation ofthat. And that is
representative, I think, of thespectrum. But then I also think
there's a , an element of thespectrum that, that represents.
Some people with autism havevery little effect on their
daily lives. It affects theirdaily lives, but, but not in a
way where they need significantlevels of services from other
(06:52):
people to get through dailylife. Whereas there are other
neighbors who have autism whoreally need a lot of support to
do their daily functioning anddaily life activities. And so I
think that is another level ofthe spectrum, is that there are
various levels of, of intensityof services. And so I hope the
term , uh, spectrum allows usto see that every individual
(07:12):
with autism is different, hasdifferent needs. And, and
really one of ourresponsibilities as providers,
as community members and asneighbors, is to get to know
every individual and find outwhat are the ways that we can
support that individual.
Speaker 2 (07:25):
Yeah. That is so powerful. What the way you
frame that, I really, reallylike that. But do we know
what's happening in the brainfor people with autism? And ,
and , and I guess that'sanother way of saying, do we
know what causes this?
Speaker 3 (07:38):
Yeah. So let , let's start with the brain and then
I'll, I'll turn into like, yeah. What , what co what causes ,
um, you know, there's some verylarge scale evidence from, from
brain imaging to suggest thatthere might be some, some
consistent patterns. Uh, somaybe people with, with autism
have slightly smallerhippocampus, slightly enlarged
amygdalas, different parts ofthe neuroanatomy that are, are
(08:00):
slightly different over, overthe large scale. One thing
that's really interesting isseeing, they , they're using
MRI now to map connectivity ofpathways, which is just
beautiful science and beautifulimaging. And you can see the
way that different parts of thebrain connect with each other.
One of the things , uh, that isseen is people with autism
(08:23):
actually have veryindividualized idiosyncratic
patterns. So they have maybevery strong visual pathways or
very , maybe very strongconnections between visual
pathways a and language. Sothey may have very unique
strengths within their brainpathways that are really re uh
(08:44):
, really strong. And that's,it's , that's a cool thing to
see that our , our neighborswith autism have, have some
incredible unique strengthsthat are visualized in the
brain.
Speaker 2 (08:54):
You can actually see them on advanced imaging like
an mri . Yeah.
Speaker 3 (08:57):
Yeah. There's, there's a , there's a professor
out of Colorado State namedTemple Grandon . She has autism
and , uh, speaks, she , shestudies animal sciences, but
she speaks a lot about livingwith autism and, and what ,
what we can do to help ourneighbors with autism. And she
talks about how her, she , hervisual cortex has been , uh,
mapped out. And you can see inthe imaging, it's just so much
(09:20):
bigger than, wow , frankly,yours are my , you know, yours
are mine, David. Um, but it's,it's a remarkable thing. But,
you know, Dr. Granton alsotalks about how that these
strengthened pathways inwhatever way they are, are ,
are the seeds of someincredible things in our
community. You know, we, shetalks about , uh, a , a young
Albert Einstein, you know, anda young Albert Einstein didn't
(09:40):
talk till he was the age ofthree. Mm-hmm .
he liked his blocks in acertain way and lined them up
in a very certain way. Would hehave been diagnosed with
autism? Very likely. You know,very, very likely. And,
Speaker 2 (09:51):
And is not what people call the genius. If you
think of a genius, you think ofEinstein a
Speaker 3 (09:55):
Absolutely. The , the prototype of a genius that
Speaker 2 (09:57):
Prototype. And
Speaker 3 (09:58):
What does that mean?
It means that sometimes thesesymptoms that we just talked
about, this, this, this focuson certain things, this
interest in certain things ,uh, it can sometimes be the
seeds of the things that changethe world.
Speaker 2 (10:09):
Absolutely. So what causes
Speaker 3 (10:11):
It? So maybe it's easier to tackle Dr. Hilden .
What does not cause , what doesnot cause, what does not cause
autism? Um, I think there'sbeen a lot of talk about autism
over the last 30 years. And ,and one of those talks has
been, oh, is it vaccine related? I think one thing we can say
with as much proof as there isunder the sun,
Speaker 2 (10:30):
As certain as we can possibly be
Speaker 3 (10:32):
A , about anything that , uh, vaccines don't cause
autism. And , and I, and Iwanna make that a as
straightforward as
Speaker 2 (10:38):
Possible. I appreciate you laying that out
there ,
Speaker 3 (10:41):
And, and I , I also think weoftentimes run, and I know
parents often think about whatdid , what , what am I doing?
What did I do? Yeah . Is it ,uh, no , we , we know. It's not
something that parents are, areconsuming or doing. You know,
this is not about, it's notabout parents. We think, and we
know that there are , uh,there's a genetic component to
(11:02):
autism. The challenge withthat, Dr. Hilton, is that
there's over a hundreddifferent genes that have some
connection peripherally or morestrongly to autism. And so to
try to synthesize that, it's,it's a difficult thing because
there's, it is somultifactorial.
Speaker 2 (11:18):
I love your message though. It's not what you did,
folks, you know , parents, youdidn't do this. Know your
vaccine, do and do it, andnothing you did. You don't,
this isn't your , somethingyou're responsible for. It's
nothing you personally did.
Speaker 3 (11:30):
Uh , no. And , and you know, we , we also know
that there's a, there is agenetic component because we
see that in, we do see it infamilies . So we will see, for
example, in in siblings,there's a higher preponderance
or concordance in , in twins ofa sibling having autism, and
then , uh, you know , theirsibling having autism. Right ?
Um, so, so we know that thereis a genetic component. We know
(11:51):
that there's some , um, somecorrelation, though the science
isn't great about paternal andmaternal age. The older we get
as we have children can havesome correlation. But the truth
is, Dr. Hilden , I, I thinkhere, here we see a hundred
genes. We see , uh, brainconnectivity in certain spots.
I , I think if we have youngscientists and researchers out
(12:12):
there who really wanna push theboundaries of knowledge, I , I
think one, learning the braingenerally is, is the new
frontier. And is the frontierof where, where science is
going. But I think autism inparticular is another space
that we have a lot to learn andhow you uncouple these hundred
genes.
Speaker 2 (12:28):
When we come back, we're gonna talk about
diagnosis and then we're gonnatalk about living with autism.
Stay with us. We'll be rightback after a short break.
Speaker 1 (12:37):
You are listening to the Healthy Matters podcast
with Dr. David Hilden . Got aquestion or comment for the
doc, email us at HealthyMatters hc m e d.org , or give
us a call at six one two eightseven three talk. That's
[inaudible] 8 7 3 8 2 5 5. Andnow let's get back to more
healthy conversation.
Speaker 2 (13:01):
You , you used the word earlier that millions of
Americans have this, so howcommon is it? Yeah,
Speaker 3 (13:07):
Right now they're saying , uh, as of this year,
one in 34 children are, arediagnosed. So we're talking
countrywide. About 2% ofAmericans have autism or on the
autism spectrum.
Speaker 2 (13:18):
Is that on the rise on the fall? Is it the same?
Speaker 3 (13:21):
If you had asked me this question in 2000, Dr .
Hedon , we would say one in 150Americans. So I would,
Speaker 2 (13:28):
That would conclude It's on the rise. Is that
wrong? You
Speaker 3 (13:31):
Would, you would be accurate that the number of
diagnosed people on the autismspectrum is on the rise now?
Was it that we wereunderdiagnosing, did we not
recognize? Uh , I , I thinkthat's a huge piece of it that
Speaker 2 (13:44):
Seems like it's enormous, that we simply
weren't identifying it as much.
And this
Speaker 3 (13:48):
Is a relatively young field, Dr. Hilden . Yeah
. You know, it , it wasn'tuntil 1940 that the first sort
of description of 11 kids withsome varia variation in
communication , uh, wasdescribed. And then, you know,
it wasn't until the , you know, 1970s, eighties till you got
a little bit more discussion onthat started to, to recognize.
(14:08):
And the amount of educationwe've done to providers, the
community ha , has beenenormous. And I think that's a
huge reason we're starting toidentify , uh, more folks with
some of these symptoms, youknow, landing on the autism
spectrum. I think it's alsopart and parcel, and I know
we're gonna talk about this, ofwe're recognizing more and
more, and , and this is part ofthe research advent, it's part
(14:29):
of the clinical advent , isthat we need to make early
diagnosis to help folks alongtheir path, right? We need to
make the diagnosis in order toget them services and the kinds
of therapies that, that willbenefit them for the rest of
their lives. And so, I , Ithink we as providers are
learning a lot. Our diagnosisis getting better. The
community knows a lot more. And, and so I think all those
(14:52):
things have, have seen a shiftfrom one in 150 to one in 34.
Is
Speaker 2 (14:55):
It more common in certain people are at some
groups more at risk, are boysor girls more at risk? Mm-hmm.
Speaker 3 (15:03):
Yeah. So, so you know, we talked a little bit
about how families, if you havea , a member of your family ,
uh, and a sibling , uh, aparent with, with autism, then
that is, is a risk. Uh, we knowthat it is more commonly
diagnosed in boys four times asmuch diagnosed in boys . So
it's, it's a pretty big disdisparity in our diagnosis. We
don't have a great reason forthat Exactly. But I think it
(15:24):
does beg the question of are wediagnosing it well and
consistently, and it'ssomething we need to be
thinking about a lot. Thepopulation rates are very
comparable across the world.
That's just looked at a mapthat mapped out by color on ,
you know , shading color on themap, the rates of autism. It
was a uniform map for the mostpart because it was a , just
(15:45):
about the same when no matterwhere you went, there's some
slight variation. France hasthe lowest diagnostic rate and
Qatar has the highest in the ,in the world. However, it is
not a huge disparity when youcompare it to, to other types
of illnesses in thedisparities. And if you look
at, in the United States, ifyou look at , uh, autism rates
by race and ethnicity,remarkable. And I have it here
(16:06):
with me, David, I want to hear2.1%, 2.2%, 2.2%, 2.3%. And
that's across different
Speaker 2 (16:14):
Racial groups.
Across racial groups. So it isthe same remarkably, almost
identically the same acrossracial groups. It ,
Speaker 3 (16:21):
It , it's remarkably similar. And, and
Speaker 2 (16:23):
That's shocking to me. It it
Speaker 3 (16:24):
Is, it's, it's, it's a surprise. Now, I will say, I
, I think if we we're lookingat diagnoses , um, yeah , we
know that our data suggeststhat we are slower to make the
diagnosis in African Americanand people of color. So it's,
it's a disparity that we needto address and we need to get
better at. And that, that'spartly outreach. It's partly
our conversations and, andmaking sure we're doing a good
(16:47):
job of, of screening anddiagnosing.
Speaker 2 (16:49):
How is it diagnosed?
Speaker 3 (16:50):
There's a few ways that we approach this
conversation. One, and , andit's always so welcome . And
one of the things I wannaencourage every family out
there is, one, talk to yourkid. Play with your kid , sing
to your kid. Uh, have have alot of conversations with them
and then check in with the c dt. Check in with your
pediatrician about what are thekinds of things that we would
expect a child at any given ageto do. And this starts from
(17:11):
birth two months, four months,nine months, all the way
through and just is my childdoing the things that I would
kind of expect? And
Speaker 2 (17:18):
Parents don't always know that
Speaker 3 (17:19):
A absolutely not.
And , and there's some reallygreat apps, there's some really
great websites. And then pleaseuse your providers as a, as a
resource to find out, oh , whatshould my kid be doing
approximately at this age? Andthere's always variation. I
wanna make that very clear. Buta at any point if you have
concerns that your child ismaybe not doing what you would
think, bring that up. Cuz thatis always a very welcome way to
(17:41):
begin a conversation. Well ,how do we make this, this
diagnosis? First, I wanna makeit clear that pediatricians
and, and family docs, at 18months and two years, we'll
always do a screening. We'llask a bunch of questions about
development and it'll give us asense of are there some
symptoms that might fall alongthe autism spectrum? And
Speaker 2 (17:59):
You do that with all kids.
Speaker 3 (18:00):
We do that with every kid. And , and so one of
the great things aboutscreening tools is that we use
it with every child. And , uh,we, we get a sense of if
there's any clues there. And ifthere are clues, we'll do some
further testing, furtherquestions, and we'll make
referrals to some of ourcolleagues who do deeper
testing and deeper analysis todetermine whether these
communication and behavioralsymptoms really are existing.
(18:23):
Now
Speaker 2 (18:23):
Is that a neurologist or are there people
who specialize specifically inautism spectrum?
Speaker 3 (18:29):
We , we are blessed with some incredible colleagues
and they fall along a coupledifferent avenues and
professional venues. So we dohave some pediatric
neurologists who, who , whowill do this. But , uh, more
commonly we have incrediblepsychologists in our, in our
community , uh, clinicalpsychologists, pediatric
psychologists who will sit downand do incredible conversations
and evaluations with, withyoung people determining
(18:49):
whether they have some of thesesymptoms. There are , there are
standardized scales thatthey'll use , uh, standardized
conversations and tests thatthey'll do with kids and, and
determine whether they fit thiscriteria for, for autism. But
one thing too, David, you don'tneed to wait for a screen,
right? Like we as pediatricianswill do the screen and we'll do
it at 18 and 24 months. But atany point, if a parent feels a
(19:14):
question or a concern, we canalways get that referral made
to our psychology colleagues,to our neurology colleagues.
Uh, we have developmentalpediatricians who, who
specialize in this space. Andthey are awesome. They're
wonderful. It's a funappointment in many ways cuz
it's , uh, it's a really niceplay event and we can get you
to those folks , uh, if youhave any concerns. So
Speaker 2 (19:35):
That , that's the message to parents. If you, if
you have questions about yourchild, ask your pediatrician.
Speaker 3 (19:40):
Yeah. And it doesn't matter whether we call it
autism spectral disorder, aspeech delay, a difference in
behavior. If we can get kidsmore therapy, more practice
with conversations andsocializations and ,
Speaker 2 (19:52):
And the sooner the better
Speaker 3 (19:52):
And the sooner the better. Frankly, the label
doesn't matter. And it , itmatters that we are helping the
young people do more andpractice more and, and helping
parents to help their kid. I'dlike
Speaker 2 (20:03):
To shift the r the rest of our conversation about
living with autism.
Speaker 3 (20:08):
So first thing I wanna acknowledge is that I
think anytime you give a kid adiagnosis of anything, it it ,
it's a , it's a shock and it'sa , it's a whoa, it's a whoa
moment for any, any parent. Weas pediatricians, we as a
community are there to walk,walk beside families. Um, so
there are some incredibleresources out there. There's
organizations that aresupporting families with
(20:29):
autism. So there , there'sFrazier, there's St . David,
there's a number of , uh,Minnesota Autism Center.
There's a lot of greatorganizations right here in our
community that are supportingwhat I, what I think it
represents. What does it meanwhen you , uh, you know, what
does life look like? So firstand foremost, I think at an
early age, it means we're gonnaget you the extra support.
We're gonna get you the extratherapy, we're gonna do the
extra practice. Minnesota and ,and frankly, our early child
(20:53):
infrastructure is, is reallyexceptional. Right away we make
a , we make a referral tospeech therapy, the kinds of
therapies that will support ,uh, a child with autism,
various modalities of therapythat, that help kids learn a
lot of the skills we're talkingabout. Uh , but we also have
the school districts, you know,we will refer to the school
district who will provide extratherapies and extra support for
(21:15):
kids in that first three yearsand beyond, all the way through
their educational career. So Ithink one of the key elements ,
uh, for I would encourage allparents to think about is if
you get that diagnosis, livingwith autism means finding the
resources that are gonna besupportive and relying on the
professionals around you tohelp you get to those
resources. So that's the ,that's the first thing. Uh ,
the second thing I'll say,David, is the spectrum is huge.
(21:37):
And for each individualthereafter, it's gonna be, it's
gonna be variable. Some kidswill need some minor supports
in their classroom setting.
Some kids will need the, thesocialization and friend groups
that come from a community andother kids may need significant
support. And , and thatspectrum can be so broad as we,
as we talked about earlier. Andso that will look very
(21:59):
different for each family. ButI think having a navigator,
having a someone who will walkalongside you becomes crucial.
What about
Speaker 2 (22:05):
Things like , uh, social relationships mm-hmm.
they're , you know, whererelationships are difficult for
all teenagers. Yeah. How do,how do young adults, teenagers
manage that? Yep .
Speaker 3 (22:19):
So it , it is through various modalities of
therapy. It's a lot of what ,um, our, our pediatric
therapist will work on withkids. Mm-hmm .
how do we make friends? How dowe take turns? How do we do the
elements that are gonna make ussuccessful in a classroom
setting? Uh , I think one ofthe things I think about , um,
our , our pediatric therapistsdo an incredible job of helping
(22:39):
our kids with makingadaptations to be successful in
their world, right? I thinkthey do an incredible job long
Speaker 2 (22:44):
Into adulthood
Speaker 3 (22:45):
Then long into adulthood. But one of the
things that I think we asproviders, one of the things
that I think we as a communityand, and as organizations can
do is help the communityunderstand and adapt and make
places more welcoming, more ,um,
Speaker 2 (22:59):
Absolutely
Speaker 3 (23:00):
Amenable, more, more friendly and, and more honoring
of our neighbors with autism. Aand so I think it's a, it's a
simultaneous process of, ofsupporting our kids, but also
supporting our communities to,to learn to
Speaker 2 (23:11):
Be a little bit more welcoming. Not all spaces were
designed intentionally orotherwise for people living
with autism perhaps. So to wrapit up, it sounds to me, Kris ,
that , um, the world ischanging with regard to autism,
that there are more resources,there are, there's more
awareness at least of autism atleast, I hope so. What thoughts
would you leave us both forpeople living with autism and
(23:34):
for the communities about whatthe future should look like
with regard to people livingwith autism? Yeah, I,
Speaker 3 (23:41):
I I think we , we don't know , uh, what what will
happen next with our kids,right? None of us do. But from
an early age, talk to them,sing to them, play with them,
love them, love them, lovethem. And then use the
resources around you to help ,uh, guide next steps. Yeah. I'm
so excited that the communityis beginning to realize that,
(24:02):
that the autism spectrum is, iswide. It , it's broad and it
represents so many of ourneighbors with so many
different talents. And, and Ithink what I would hope is that
we begin to recognize thateveryone , uh, with autism,
everyone on the spectrum hasincredible talents, incredible
gifts, and that while they'reworking hard , uh, all of our
neighbors with autism areworking hard to learn skills.
(24:24):
Uh, we as a community should beworking equally as hard to
appreciate the incredible folksthat , that surround us.
Speaker 2 (24:29):
I will take that to heart. I think that's probably
my number one take home messagefrom this conversation with you
, Kris , is that the community, um, needs to do its part and
it's a privilege to, to do so.
What a great conversation todaywith Dr. Christian Subramanian
here from the Department ofPediatrics at Hennepin
Healthcare . I have learned awhole bunch. I hope you have as
well. If you like what youheard, please share the podcast
(24:51):
with your friends, leave us areview, and I certainly hope
you'll join us for the nextepisode. It's going to be a
great one. And in the meantime,be healthy, be well, and don't
forget to wear your sunscreen.
Speaker 1 (25:03):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy Matters hc m ed.org or call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. And finally, if you
(25:26):
enjoy the show, please leave usa review and share the show
with others. The HealthyMatters Podcast is made
possible by Hennepin Healthcarein Minneapolis, Minnesota, an
engineered and produced by JohnLucas At Highball Executive
producers are Jonathan Comitoand Christine Hill. Please
remember, we can only givegeneral medical advice during
this program, and every case isunique. We urge you to consult
(25:47):
with your physician if you havea more serious or pressing
health concern. Until nexttime, be healthy and be well .
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